Ultrasonic Scaling in Pacemaker Patients
Yes, ultrasonic scaling is permitted in patients with permanent pacemakers, as contemporary evidence demonstrates no clinically significant interference with modern pacemaker function during routine dental use. 1
Evidence Quality and Strength
The most recent and highest-quality evidence comes from a 2015 prospective clinical study that directly tested ultrasonic scalers on 32 patients with implanted cardiac devices (12 pacemakers, 20 ICDs). This study found no significant clinical interference with sensing or pacing functions in any patient during actual clinical use. 1
While minor telemetry interference was noted on the cardiac programming unit during ultrasonic scaler operation, this had no clinical impact on patient safety or device function. 1
Reconciling Contradictory Evidence
Earlier in vitro studies from 1998 and 2010 suggested potential interference:
- In vitro testing showed magnetostrictive ultrasonic scalers could inhibit pacing at distances up to 37.5 cm from the device 2
- Laboratory conditions demonstrated interference at 15-23 cm with certain pacemaker models 3
However, real-world clinical studies directly contradict these laboratory findings:
- A 2013 in vivo study of piezoelectric scalers showed no interference with ICDs during actual patient use 4
- The 2015 prospective clinical trial confirmed safety across multiple contemporary device models 1
The discrepancy exists because in vitro testing uses artificial conditions that do not replicate actual clinical scenarios, tissue dampening effects, or modern device shielding technology. 1
Practical Clinical Approach
Safe Use Protocol
- Proceed with ultrasonic scaling without special restrictions in patients with modern pacemakers (post-2000 devices) 1
- Maintain normal working distances—no need for excessive separation from the pacemaker generator 1
- Avoid prolonged continuous activation directly over the pacemaker generator site as a precautionary measure, though clinical evidence does not mandate this 2, 3
Patient Selection Considerations
- Non-pacemaker-dependent patients: No special precautions needed beyond standard technique 1
- Pacemaker-dependent patients: While the 2015 study excluded these patients, the absence of any interference in tested patients suggests safety, but maintain heightened awareness 1
Device-Specific Factors
- Piezoelectric ultrasonic scalers appear safer than magnetostrictive models based on available evidence 4
- Contemporary pacemakers (manufactured after 2010) have superior electromagnetic shielding compared to older models 1
Common Pitfalls to Avoid
- Do not deny necessary periodontal treatment based on outdated in vitro data—the clinical evidence supports safety 1
- Do not confuse telemetry interference (which affects monitoring equipment) with actual device malfunction (which does not occur) 1
- Avoid relying solely on patient symptoms to detect interference, as this is unreliable; however, modern devices make this concern largely theoretical 5
Perioperative Context
The 2014 ESC guidelines address electromagnetic interference concerns during surgery, noting that bipolar electrocautery and proper grounding minimize risks—principles that extend to dental equipment where ultrasonic scalers pose minimal electromagnetic threat. 6